Provider Demographics
NPI:1427449339
Name:ELEONOR LOYOLA GRIFFITH, DO, PC
Entity type:Organization
Organization Name:ELEONOR LOYOLA GRIFFITH, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEONOR
Authorized Official - Middle Name:LOYOLA
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-984-9004
Mailing Address - Street 1:1611 CREEKSIDE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3490
Mailing Address - Country:US
Mailing Address - Phone:916-984-9004
Mailing Address - Fax:
Practice Address - Street 1:1611 CREEKSIDE DR STE 101
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3490
Practice Address - Country:US
Practice Address - Phone:916-984-9004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0A12052208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty